By Your Sis: Ghada Odeh :)
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- Philip Grant
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1 By Your Sis: Ghada Odeh :)
2
3 Hx: Chest pain ACS. Hx.: Cough Bronchiectasis. Hx: Epigastric pain Peptic ulcer disease. Hx: Joints Pain SLE. Hx: Hematurea post-strep Glomerulonephritis. Hx: Jaundice Chronic hepatitis B (liver cirrhosis). Hx: 21 YO female came to ER complaining of jaundice for 4 days duration (& give your DDx.) Hepatitis A. Hx: Dark urine & Oliguria post-streptococcal GN.
4 Hx: SOB (6 mon.) Cystic fibrosis + pneumonia. 23 YO female pt, productive cough, fever 39, married for 4 yrs but can t get pregnant, has chronic diarrhea, has a brother & sister with the same complain. Hx: 27 years old male complain from joint pain & chest pain RA. Hx: 60 years old female complain from fatigue (her HB=8). Hx: 24 YO female with Hx of bloating for 6 years, Her Hb 7.4, MCV 65 CELIAC disease.
5 Hx: Abdominal distention (1 month) 30 YO male, all GI symptoms are -ve except for heartburn. >> Ask about 4 F s ( fluid, fat, feces, flatus ), it turns to be fluid because he has lower limb edema. >> Ask about causes for fluid over load (malnutrition, Malabsorption, heart, liver or kidney failure), everything is ve, but the pt has family history for liver disease (his mother has chronic hepatitis). What s your diagnosis? ascites due to decompensated liver failure (viral hepatitis). What s the treatment? Antiviral (interferon, ribavirin ).
6 Hx: 30 YO male with back pain for 1 month, Give 2 DDx: a- ankylosing spondilitis. b- reactive arthritis. Hx: 20 YO female with HB=6 hemolytic anemia. Hx: 20 YO male presented with chest pain of 2 days duration. 1) What's your Dx? Acute pericarditis. 2) Mention 2 investigations you would like to do. ECG & ECHO.
7 Hx: 27 YO female Pt has decrease in Weight in last 18 days Hyperthyroidism. Hx: 33 YO male Pt has decrease in Weight in last 3 months Diabetes mellitus. Hx: 17 YO female pt with dizziness & SOB. Her Hb. was 6. Iron Deficiency anemia due to massive menorrhea. Hx: pt presented with SOB & had an ejection fraction less than 30% Idiopathic cardiomyopathy.
8 Hx: 34 YO female came to ER complaining of epigastric pain for 2 weeks (& give your DDx.) Drug induced peptic ulcer voltarin for back pain for 4 weeks. Hx. 53 YO male pt came to ER complaining of cough for 1 week (& give your DDx.) Pneumonia. Hx: 21 YO male came to ER complaining of cough for 2 yrs duration (& give your DDx.) Asthma. Hx: A 33 YO male pt with lower limb edema (+ve : Bilateral, progression with daily activity, facial Bluffness, urinary symptoms; polyurea, proteinure HTN). DMرغوة (15 years duration, on insulin),
9 Hx: 57 YO male pt presented with palpitation (pt has rheumatic fever Hx) Atrial fibrillation. Hx: 49 YO female pt, known case of DM, came to follow up for her diabetes. Evaluate her condition. Hx: Diarrhea & abdominal pain 7 months duration DDx: IBD, diverticulitis, infectious diarrhea. Hx: Abdominal pain (epigastric region) PUD. Hx: 67 YO female with SOB for the last 2 wks, She had orthopnea & PND, she also was a smoker RHF.
10 Hx: 67 YO male presented with Hemoptysis for 2 weeks. Bronchogenic Carcinoma. Tests: CXR, CT-scan, Bronchoscopy. Hx: 31 YO female pt presented with fatigue for 6 months & her Hb=6. Iron deficiency Anemia due to increase demand (she delivered 8 children). Tests: CBC, Ferritin, Iron, TIBC, Blood film.
11 Hx: 21 YO male medical student presented with cough for 1 year. Exacerbation of bronchial asthma. Investigation: Stress test (Air hyper-responsiveness). Results do you suspect? FEV1/FVC <80%, when stress is encountered it declines further, & when given beta-2 agonist (salbutamol) it has to rise by (12-15%). Hx: Painless neck mass, it was asymptomatic diffuse goiter. Hx: 24 YO female pt presented with neck swelling for 3 months. DDx? Lymphoma, Bronchogenic carcinoma, TB [B symptoms "or constitutional" symptoms were positive]. Name one only test to diagnose your pt definitely >> Excisional lymph node biopsy (total removal of the LN).
12 Hx: A 65 YO male, hypertensive, well controlled on ACE inhibitors, complains from red urine for 3 days duration. - Q1: What's the best initial test to be done? >> Urine analysis. - Q2: if his Urine analysis was Positive (dipstick) for blood but it wasn't RBC's, what would it be? (give two differentials): >> Myoglobin or Hemoglobin. Hx: Pt presented with Hb=8 in the last CBC thalassemia, others had hereditary spherocytosis.
13 Hx: a 24-year old male presented with jaundice started 5 days ago. (Acute Hep. A) Hx: young male presented with red urine. (Postinfectious glomerulonephritis) Hx: Lower limb swelling (Lower limb DVT). Hx: Abdominal pain (PUD). Hx: Joint pain with chest pain (SLE). Hx: Chest pain (MI). Hx: Hemoptysis (Lung CA). 13
14
15 P/E: Abdominal exam (from A to Z!) Pt was normal. P/E : abdominal Hepatosplenomegaly. P/E: abdominal Cushing s due to steroids therapy after kidney transplant. P/E: Abdominal Hepatomegaly. P/E: Inspect & palpate the abdomen. - The pt had polycystic kidney disease (a mass in each flank) P/E: Precordial exam. (Midline scar: Suggesting valve replacement or CABG / aortic click may be due a prosthetic valve). P/E: Pericardium mitral regurgitation.
16 P/E: Anterior or Posterior Chest mostly; findings will be wheeze & basal crepitations (bilateral lung crepitations in pulmonary edema & lung fibrosis). Other students were to examine hand & face, Scleroderma,rheumatoid arthritis, Acromegaly. P/E: a pt with clubbing, central cyanosis, conjuctival congestion; what's the likely Dx? Congenital cyanotic heart disease with 2 o polycythemia. Examination (one of the following): Precordium. Abdomen. Posterior chest.
17 Good Luck :)
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